| NPI | 1770087207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S3457) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61118434) |
| 207P00000X Emergency Medicine (Licence: ID MC-2873) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-03-15 |